title: Care managers' confidence in managing home-based end-of-life care: a cross-sectional study.
abstract: BACKGROUND
  There are increasing occasions for care managers (CMs) to manage end-of-life (EOL) situations for older persons at home, in Japan. However, many CMs report anxiety, difficulties and low confidence in managing such care, although confidence is considered a significant determinant of professional performance. This study examined the confidence of CMs at managing home-based EOL situations and its factors.
  
  
  METHODS
  Participants of this cross-sectional study were CMs from 1,200 homecare agencies in Japan, which were systematically sampled from a national database. Participants were asked about their overall confidence in managing home-based EOL situations, as well as their demographic, professional and agency characteristics. Multiple logistic regression analysis was conducted to examine the factors associated with CM confidence levels.
  
  
  RESULTS
  Valid responses were obtained from 458 participants (response rate, 39.4%). Among the respondents, 81.0% (n = 371) were female; mean age 49.2 years old (standard deviation = 8.8). Their professional backgrounds included nurses (28.2%), care workers (49.8%), social workers (10.9%), and home attendants (6.1%). Approximately 70% of CMs expressed some level of confidence in managing home-based EOL situations. Multiple logistic regression analysis showed that being confident was significantly associated with having a nursing license (OR: 2.71, 95% CI: 1.26-6.19) and having an additional work responsibility other than being a CM, such as working as a homecare nurse or a home attendant (OR: 2.78, 95% CI: 1.06-4.74). Higher confidence levels were more frequently reported among those who had multiple experiences with EOL situations, compared with those who had none, or only one experience: OR=2.60 (95% CI 1.26-5.50) for those with 2-3 cases; OR=7.12 (3.21-16.56) for those with 4-10 cases; OR = 33.67 (8.14-235.19) for those with 11 cases and over.
  
  
  CONCLUSIONS
  These results suggest that CMs with direct, hands-on experience with EOL care, or who have managed multiple EOL cases, tended to be confident at managing home-based EOL situations. Given that the number of nurses working as CMs is decreasing, further research is needed to explore what support CMs need to increase their confidence, especially when the CMs do not have nursing licenses and/or experience with EOL situations.
authors.affiliation: Department of Adult Nursing/Palliative Care Nursing, Division of Health Sciences & Nursing, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
authors.forename: Maiko
authors.initials: M
authors.lastname: Watanabe
authors.forename: Noriko
authors.initials: N
authors.lastname: Yamamoto-Mitani
authors.forename: Masakazu
authors.initials: M
authors.lastname: Nishigaki
authors.forename: Yuko
authors.initials: Y
authors.lastname: Okamoto
authors.forename: Ayumi
authors.initials: A
authors.lastname: Igarashi
authors.forename: Miho
authors.initials: M
authors.lastname: Suzuki
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000592:standards; D003430:Cross-Sectional Studies; D019468:Disease Management; D005260:Female; D006699:Home Care Services / Q000592:standards; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000379:methods* / Q000592:standards